Table of Content

25 July 2013, Volume 22 Issue 4

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Macular hole: idiopathic or primary disease

HUI Yan-Nian

2013, 22(4):  217-219. 

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 Macular holes are one of main reasons for visual loss and primarily occur in eyes with high myopia and otherwise “healthy” eyes of aging people. In the latter situation, it has been recognized as “idiopathic senile macular hole”. In recent years, spectral-domain optical coherence tomography (OCT) has revealed the relationship of development of macular hole with perifoveal posterior vitreous detachment (PVD). It can be reasonably convinced that vitreous liquefaction and incomplete PVD on the maculae is the primary cause in pathogenesis of macular hole. It is therefore suggested that these two common types of macular holes can be defined as “myopic” and “senile” macular holes, respectively. It should be recommended that routine examination with OCT applied on the corresponding eyes may benefit to prevent and treat macular hole. (Ophthalmol CHN, 2013, 22: 217-219)
　　

Therapeutic target and its evaluation in glaucoma

ZHANG Xiu-Lan, ZHOU Min-Wen

2013, 22(4):  220-223. 

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Currently, the only approach proven to be efficient in treating glaucoma is lowering the intraocular pressure (IOP). IOP reduction is a remarkable mark to assess the glaucoma treatment. Target IOP is the main indicator of glaucoma individualization treatment. Besides lowering IOP to the target IOP, we should also pay attention to the IOP fluctuation and neuroprotection treatment. The target IOP should be adjusted or re-evaluated following the monitoring of optic nerve structure and visual function progression. The ultimate goal of glaucoma treatment is to prevent the visual function from deterioration, maintain patients’ visual acuity and enhance their quality of life. (Ophthalmol CHN, 2013, 22: 220-223)

Novel frizzled-4 gene mutations in Chinese patients with familial exudative vitreoretinopathy 

JIA Li-Yun, ZHANG Feng, LI Xiao-Xin

2013, 22(4):  224-229. 

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【Abstract】 Objective  To investigate the genotype and phenotypic features of FZD4 mutations in Chinese familial exudative vitroretinopathy (FEVR) patients. Design Experimental study. Participants Fifty-one Chinese patients with FEVR and 100 unrelated control subjects were recruited and complete ophthalmic examinations performed. Method The coding regions of FZD4 gene was screened for mutations by polymerase chain reaction and direct sequencing. Multiple sequence alignment was conducted to evaluate the conservancy of residues among different FZD4 homologs and human frizzled family. Genotype-phenotype correlations were also analyzed. Main Outcome Measures Gene sequences. Results Totally twelve putative disease-causing mutations were identified, nine of them novel: one deletion (P14fsX57), one nonsense mutations (S491X) and seven missense mutations (G22E, E180K, T237R, R253C, F328S, A339T and D470N). Three reported FZD4 mutations were also detected: H69Y, M105V and W496X. Remarkably, two patients, who harbored compound heterozygous mutations (H69Y with E180K or W496X), had a more severe ocular phenotype than carriers of single H69Y mutation. Conclusion FZD4 mutations were responsible for 29.4% (15/51) of Chinese FEVR patients in this study, similar to other ethnic groups. This study supported the highly polymorphic nature of FZD4 with a differential mutation profile in the Chinese population. The profile of the mutations obtained in FZD4 gene further illustrated the complexity of FEVR and provided a better understanding on the genotype–phenotype correlations. (Ophthalmol CHN, 2013, 22: 224-229)

The preliminary study of screening for fundus diseases with digital nonmydriatic fundus camera among residents of 50-year-old or elder in 2 communities in Beijing 

HAN Cui, Xu-Qing, LIU Ning, FENG Hui-Ping, HOU Bao-Jie, WU Hai-Yang

2013, 22(4):  230-233. 

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【Abstract】 Objective To evaluate the feasibility and value of screening for fundus diseases with digital nonmydriatic fundus camera in 50-year-old or elder community citizens. Design cross-sectional survey. Participants 3742 residents aged 50-year-old or elder by telephone notices and posters recruitment from Wanshoulu blocks and Tiancun blocks, Haidian district, Beijing. Methods Fundus photos were taken with digital nonmydriatic fundus camera and slit-lamp microscopic examination of the anterior segment of all subjects was performed after visual acuity examination. Cases screened as macular diseases with photos were undergone optical coherence tomography (OCT) examination. Main Outcome Measures Composition ratios of fundus diseases. Results Among all the screened 3742 subjects, 2914 subjects acquired qualified fundus photos, 13 fundus diseases were screened, including retinal arteriosclerosis (37.1%), suspect glaucoma (9.27%), aged-related macular degeneration (6.11%), diabetic retinopathy (2.23%), asteroid hyalosis (0.89%), myelinated nerve fibers (0.58%), retinal vasculitis (0.51%), epiretinal membrane of macula (1.30%), suspect macular hole (1.20%), retinal vein occlusion (0.14%), optic atrophy (0.17%), optic disc macroaneurysm (0.03%), other fundus abnormality (0.32%). Images of macular degeneration, epi-macular membrane and macular hole were compared with OCT scanning, the result consistent rate of the two methods is 86.90%. 828 subjects (22.13%) are excluded because their fundus images were unclear and couldn’t be analyzed. The rate un-evaluation of fundus images was increasing with aging. Conclusion It is an objective and feasible screening method for fundus disease with digital nonmydriatic fundus camera in most 50-year-old or elder subjects. (Ophthalmol CHN, 2013, 22: 230-233)

Prevalence and surgery status of cataract in adults aged 50 years or above in rural Shandong Province 

JIAO Wan-Zhen, ZHOU Cheng-Chao, WANG Li-Hua

2013, 22(4):  234-239. 

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Objective  To assess the prevalence of cataract, the cataract surgical coverage rate, and the cataract-blindness social burden rate among older adults aged 50 years or above in rural populations in Shandong Province, China, in 2008.  Design Population-based, cross-sectional study. Participants 17 816 individuals aged 50 years or above in three counties and one suburbs representative of the different levels of socioeconomic development. Methods Visual acuity (VA), lens and cataract operation status of all the individuals were evaluated. Main Outcome Measures  The prevalence of cataract, the rate of intraocular lens implantation, the cataract surgical coverage rate, and the cataract-blindness social burden rate. Results In 17 816 individuals, 4938 cases were suffered from  cataract; the prevalence of cataract was 27.72%. The prevalence of cataract was higher in older people, female, and illiterate persons (P＜0.01). In 310 eyes with cataract surgery, 62.58% and 10.32% of eyes were performed by the modern extra-capsular surgery and phocoemusification respectively. The rate of intraocular lens implantation was 77.10%. The cataract surgical coverage rate was 36.77%, and the cataract-blindness social burden rate was 2.12%. The cataract-blindness social burden rate was higher in the aged persons and illiterate persons (P＜0.01). Conclusion The cataract surgical coverage rate is still lower in older adults aged 50 years or above in rural populations in Shandong Province. Surgery for cataract blindness is still the first important task in prevention of blindness in Shandong Province. (Ophthalmol CHN, 2013, 22: 234-239) 

Impact of community visual test on cataract surgery rate of Shantou in Guangdong Province from 2011 to 2012 

DUAN Jue-Ni, Liang-Yuan-Bo, Tao-Ping, Lin-Xiao-Wei, Lin-Hao-Yang, Huang-Dan-Shan, Li-Gong-Hui, Zhang-Ming-Zhi

2013, 22(4):  239-243. 

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Objective To estimate the impact of visual test on improving cataract surgery rate (CSR) in communities of Shantou in Guangdong Province from 2011 to 2012. Design cross-sectional study. Participants 14 370 people aged 50 years or over from 390 communities in Shantou. Methods Visual test were performed among senior people aged 50 years or over in Shantou communities by 4 trained staffs from 2 working teams (one nurse and one administrator as one working team) of Joint Shantou International Eye Center (JSIEC) at community committee or senior center. The administrator was responsible for organization and the nurse was in charge of visual test. Participants with pinhole-corrected vision ≤ 0.3 (Standard for logarithmic visual acuity chart) were suggested to JSIEC to take further examinations including slit-lamp, funduscopy by the certain doctors who were responsible for this item. The part of people with best corrected visual acuity ≤0.3, intraocular pressure ＜22 mm Hg, lens opacity, diagnosed cataract and without surgical contraindication were offered cataract surgery. The other people with other diseases were treated by specialized departments. The number of cataract surgeries in JSIEC from August 23, 2011 to August 22, 2012 was compared with the surgery number from last year at the same period. At last, the number and the rate of people who didn’t come to take visual test or didn’t come to our center or didn’t have cataract surgery were analyzed to estimate its potential impact on improving the CSR. Main Outcome Measures The number and the rate of people with cataract who didn’t come to take the visual test and the potential reserves of cataract surgery. Results  From 2011 to 2012, 14 370 (2.29%) of 627 900 people aged 50 years or over had a visual test in communities where the total population is about 2.48 million. Of which, 3753 (26.1%) people were suggested to JSIEC because of probable cataract. 1360 (68.3%) of 1990 patients who came to JSIEC were diagnosed cataract. 807 (59.3%) of them had eventually underwent cataract surgery. However, there are still 613 500 (97.71%) senior people including 160 200 people would have pinhole-corrected vision ≤0.3 didn’t enter the community visual test. 75 300(46.98%) of them would not come to JSIEC. There would have 58 000 (68.34%) cataract patients in the people who would come to JSIEC. Eventually, 23 600 (40.68%) patients would not undergo cataract surgery. Compared to last year, the number of cataract surgeries in JSIEC increased by 807 which means the CSR in these 390 communities can increase by 325.4 after the action. Conclusion There are still a certain number of cataract patients in Shantou, Guangdong province. The community visual test is simple, easy to carry out, and it can improve CSR of community areas, even in the urban district. However, there is about half of participants with pinhole-corrected vision ≤ 0.3 didn’t follow the referring suggestion, and about 40% patients with cataract didn’t follow the cataract surgery suggestion, which need to be further studied. (Ophthalmol CHN, 2013, 22: 239-243)

Long term outcomes of ultrasound biomicroscopy in eyes with primary angle closure suspect after laser peripheral iridotomy: one year results  

MOU Da-Peng, Lin-Zhong, Wang-Ning-Li, Fan-Su-Jie, SUN Lan-Ping, Liang-Yuan-Bo

2013, 22(4):  244-248. 

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Objective  To quantitatively evaluate the long-term changes in anterior segment morphology by using of ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) in eyes with primary angle closure suspect (PACS). Design Prospective case series. Participants 55 PACS consecutive patients in Handan Eye Hospital, Hebei were enrolled. Methods Routine ophthalmic tests and UBM examination were performed at presentation and 12 months after LPI. Main Outcome Measures The parameters of anterior chamber angle in UBM images. Results AOD500, AOD750, TIA500, TIA750, ARA500, and ARA750 were significantly widen at 12 months after LPI than that at presentation in eyes with PACS (all P<0.001). The value of AOD, TIA and ARA after LPI were at least 1 time (1.08-1.14 times) wider than that of before LPI, and the parameters at 750 ?滋m anterior to the sclera spur were more significantly wide than its 500 ?滋m counterpart.  Conclusion  LPI can significantly widen the peripheral anterior angle in eyes with PACS and this effectiveness tends to be sustained at least 1 year after LPI. Parameters at 750 ?滋m anterior to the sclera spur were more sensitive in evaluating the peripheral anterior angle. (Ophthalmol CHN, 2013, 22: 244-248)

The comparison of anterior scleral thickness in fellow eyes of acute primary angle-closure glaucoma and in normals

WANG Hong-Tao, Wang-Ning-Li, Li-Shu-Ning, Mou-Da-Peng

2013, 22(4):  249-252. 

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 Objective To measure and compare anterior scleral thickness in fellow eyes of acute primary angle-closure glaucoma (APACG) and in normal eyes. Design Prospective comparative case series. Participants Fifty seven fellow eyes of 57 patients with APACG and 57 normal eyes were enrolled. Methods Anterior sclera thickness (ST) and center corneal thickness (CCT) were measured with ultrasound biomicroscopy (UBM), and the images were obtained by a same examiner scanning the center corneal area and temporal corneoscleral limbus. ST was measured at 2.0 mm posterior to scleral spur. Axis length was measured with IOL Master. Intraocular pressure (IOP) was measured with non-contact tonometer.  T test was performed, and multiple linear regressions were performed between anterior sclera thickness and other parameters. Main Outcome Measures IOP, CCT, anterior ST and axis length. Results In fellow eyes of APACG and in normal subjects, the mean anterior ST was (625.42±41.45) ?滋m, (594.42±46.06) ?滋m respectively (t=3.78, P=0.0001); the mean IOP was (16.70±3.75),  (17.00±3.92) mm Hg respectively (t=0.42, P=0.338); the mean CCT was(537.08±34.68) ?滋m,(529.90±39.69) ?滋m respectively (t=1.03, P=0.153); the mean axis length was(20.78±1.23), (23.56±2.21) mm respectively (t=8.30, P=0.000). Multiple linear regression showed that in fellow eyes of APACG, the relationship between anterior ST and ocular axis had statistic significant (P=0.0090). Equation is Y (anterior ST) =877.144-12.135× (ocular axis ). Conclusion The thicker anterior sclera might be related to the acute episode of APACG attacks. (Ophthalmol CHN, 2013, 22: 249-252)

The 18 months results of Ahmed FP-7 glaucoma valve for treatment of refractory glaucoma 

ZHU Hai-Jing, YUAN Hui-Ping

2013, 22(4):  253-256. 

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Objective To evaluate the efficacy of Ahmed FP-7 implantation in refractory glaucoma. Design Retrospective case series. Participants 45 cases (46 eyes) of refractory glaucoma in the 2nd Affiliated Hospital of Harbin Medical University. Methods Ahmed FP-7 glaucoma valve implantations were performed in all patients, and mean follow-up was 10.7±7.3 months. Main Outcome Measures Intraocular pressure (IOP), visual acuity, and postoperative complications. Results The cumulative probability of success (IOP≤ 21 mm Hg without antiglaucoma medications) was 79.8% and 74.1 % at 12 and 18 months, respectively. IOP was reduced from a mean of 45.8±12.1 mm Hg to17.3±5.5 mm Hg at 12 months and 17.6±5.3 mm Hg at 18 months (P<0.001). Visual acuity improved in 9 eyes, and no change in 35 eyes. The major postoperative complications including filtering bleb fiber encapsulation (19.6%), choroidal detachment (13.0%), hyphema (10.9%), drainage tube exposure (4.3%). Conclusion Ahmed FP-7 implantations in refractory glaucoma can control IOP in 75% of patients during 18 months follow-up. (Ophthalmol CHN, 2013, 22: 253-256)

Effect of absorbable lacrimal plug on function of tear film after femto-laser in situ keratomileusis

WANG Wen-Ying, Qi-Ying, Zhou-Yue-Hua

2013, 22(4):  257-260. 

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Objective To evaluate the effect of absorbable lacrimal plug on tear film after femto-laser in situ keratomileusis (LASIK). Design Prospective case series. Participant 30 consecutive patients (60 eyes) with myopia and mild dry eye received bilateral LASIK from March to July 2012. Methods One eye of patients was randomly received absorbable lacrimal plug (VisiPlug) implantation, while the other eye was as control group of un-implantation. Schirmer I test (SIt), tear breakup time (TBUT), fluorescent staining of cornea, tear meniscus examination with optical coherence tomography were performed before and 1 week after LASIK. Main Outcome Measures SIt, TBUT, score of fluorescent staining; area, height and depth of tear meniscus. Results  On the 7th day after LASIK, there were no significant difference in all values between lacrimal plug implantation group and without lacrimal plug implantation group: SIt 9.7±1.18, 8.3±1.35 mm (t=-0.53, P=0.052), TBUT 6.63±0.34, 6.53±0.40 s (t=0.209, P=0.836); area of tear meniscus 0.020±0.002, 0.020±0.002 mm2 (t=-0.106, P=0.916), height of tear meniscus 207.40±8.59, 215.40±11.10  μm(t=-0.777, P=0.444), depth of tear meniscus 177.77±7.10, 180.60±7.00 μm (t=-0.377, P=0.709). Score of fluorescent staining (median 0, 0) (Z=0.707, P=-0.480). In lacrimal plug implantation group, SIt 9.7±1.18 mm, 7.17±1.03 mm (t=-2.019, P=0.023) and TBUT 8.3±1.35 s, 7.9±1.25 s (t=-2.359, P=0.025) were significantly higher postoperatively than preoperatively, while in the control group there were no significant difference postoperation compared to preoperation in all indexes. Conclusion During short follow-up of this study it is showed that it is not necessary to implant absorbable lacrimal plug for myopia patents with mild dry eye after LASIK. (Ophthalmol CHN, 2013, 22: 257-260)
 

Comparison of flaps created with Ziemer LDV Femotolaser and the Moria M2 microkeratome

ZHAI Chang-Bin, ZHANG Jing, ZHOU Yue-Hua

2013, 22(4):  261-265. 

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Objective The aim of this trial was to compare the features of corneal flaps created using Ziemer LDV femtosecond laser and the Moria M2 microkeratome 90 ?滋m-knife. Design Prospective comparative case series.  Participants One hundred and seventy-six eyes of 88 patients were enrolled in this clinical trial. The patients were randomized divided into the Ziemer LDV femtosecond laser group and Moria M2 microkeratome 90 ?滋m-knife with matching demography. Methods Fourier-domain optical coherence tomography (RTVue OCT) was used to measure flap thickness using 28 settings on the 176 corneas at one week postoperatively. The features of the LASIK flaps were analyzed on the basis of the outcomes. Main Outcome Measures The thickness and shape of corneal flap. Results The mean flap thickness of the Ziemer LDV femtosecond laser group was considerably thinner than that of the Moria M2 microkeratome 90 ?滋m-knife group (106.03±6.64 ?滋m versus134.41±11.31 ?滋m) (P<0.01). The mean deviation between the achieved and attempted flap thickness was smaller in the Ziemer LDV group (7.15±4.89 ?滋m) than in the Moria M2 90 group (29.51±14.31 ?滋m) (P<0.01).  Conclusion The shape of flaps created using the Ziemer femtosecond laser is more uniform and closer to the expected thickness of 110 ?滋m than the ones created using the Moria M2 90 microkeratome. And Ziemer femtosecond laser should be the first choice for thin flap Lasik. (Ophthalmol CHN, 2013, 22: 261-265)

Clinical observation of  near visual acuity and distance visual acuity in amblyopia children

WANG Li-Li, LU Wei, FU Tao, SU Qing

2013, 22(4):  266-268. 

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Objective To evaluate the differences between near visual acuity and distance visual acuity in the children with amblyopia. Design Retrospective case series. Participants Eighty-one children (139 eyes) with amblyopia. Method The refraction of eighty-one children was corrected. The near visual acuity and distance visual acuity were measured by Standard Logarithm Distance Visual Acuity Chart and Standard Logarithm Near Visual Acuity Chart. The patients were grouped with different causes, different age, and different refraction.  Main Outcome Measures The mean near visual acuity and distance visual acuity. Results The mean near visual acuity in ametropic, anisometropic and strabismus amblyopia were 0.48±0.27，0.47±0.28 and 0.45±0.30, respectively; and the mean distance visual acuity were 0.46±0.22, 0.40±0.20 and 0.43±0.30, respectively (all P＞0.05). The mean near visual acuity in groups age 3~≤5, >5~≤7 and >7~12 were 0.41±0.23，0.56±0.29 and 0.46±0.31, respectively; and the mean distance visual acuity were 0.39±0.18, 0.52±0.22 and 0.42±0.23, respectively (all P＞0.05). The mean near visual acuity in group ≤+4.00 D and ＞+4.00 D were 0.45±0.26 and 0.48±0.28, respectively; and the mean distance visual acuity were 0.40±0.30 and 0.46±0.21, respectively (all P＞0.05). Conclusion There is no significant difference between near visual acuity and distance visual acuity in the patients with different causes, ages, and refrections amblyopia. （Ophthalmol CHN， 2013, 22:  266-268）

The study of cytokines in aqueous humor of complicated cataract after vitrectomy combined with silicone oil injection

ZHANG Ling, SONG Xu-Dong, TAO Jing, YANG Shuang, WEI Ying-Li

2013, 22(4):  269-272. 

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Objective To compare the concentrations of cytokines in aqueous humor of age-related cataract eyes and complicated cataract eyes after vitrectomy combined with silicone oil injection, and to investigate the relationship of cytokine concentrations with complicated cataract resulted from vitrectomy.  Design Experimental study.  Participants 19 eyes of complicated cataracts after vitrectomy combined with silicone oil injection and 11 eyes of age-related cataracts were enrolled into experiment group and control group, respectively. Method The cataract surgeries were performed 3 months to 6 years after vitrectomy combined with silicone oil injection. Aqueous humor of 0.1-0.2 ml was collected for each patient during cataract surgery. The concentrations of cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-10, TNF-α, IFN-γ) in aqueous humor were measured with flow cytometry. Main Outcome Measures The concentrations of cytokines. Result The concentrations of IL-6 and IL-10 in the experiment group is 199635.64±28156.5 fg/ml and 273.57±206.7 fg/ml, respectively, both significantly higher than the concentrations in the control group (3340.96±1970.36 fg/ml and 117.45±64.77 fg/ml, respectively). For those two cytokines, there is statistic difference between the experiment group and the control group (P<0.05). There is no statistic difference between the experiment group and the control group for the other six cytokines. Conclusion Based on the study of the limited samples, the concentrations of IL-6 and IL-10 in aqueous humor of complicated cataract eyes after vitrectomy combined with silicone oil injection is statistically higher than in normal controls. The IL-6 and IL-10 may result to or accelerate the occurrence of complicated cataract. (Ophthalmol CHN, 2013, 22: 269-272)

Implications and prospects of multi-media teaching in ophthalmology

WAN Xiu-Hua, WANG Ya-Xing

2013, 22(4):  279-281. 

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Multi-media teaching has been an integral part in ophthalmological teaching. Comparing with traditional mode, the new teaching method brings a more vivid and interesting experience to students and helps them have a better understand, which results in a better prospect. Students can also grasp the knowledge and techniques more quickly with multi-media feaching. Multi-media teaching will become more interactive, synchronous to new academic development, and courseware will be more internet-based in the future. (Ophthalmol CHN, 2013, 22: 279-281)